Epilepsy Flashcards
What is the most common reason for blackout?
Vasovagal Syncope
What can cause a blackout?
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Non-epileptic attack Narcolepsy Migraine
What questions are important to ask someone who has blacked out?
What exactly were you doing at the time? What warning feelings did you get? What were you doing the night before? Had you been drinking? Have you ever had something similar? How did you feel afterwards? Any signs on injury, tongue biting or incontinence?
Why should a third party history be done for a blackout?
To gather information on observations of the attack
What should be asked to a witness history of a blackout?
Observations before and during the attack colour of the patient Noises Foaming of the mouth Behaviour following the attack Any movements during the attach Focus on: Before During After
Which sex is more likely to have a non epileptic attack?
F
What past medical history information could be relevant to a blackout episode?
Head injury
Birth trauma
Febrile convulsions
What is a febrile convulsion?
Fit or seizure brought on by fever
What happens in vasovagal syncope?
There is a sudden drop in HR and BP
Causing lack of perfusion to brain and fainting
What is syncope?
Fainting
With a temporary loss of consciousness
What prodrome symptoms are there for syncope?
Light headed Nausea Hot Sweating Tinnitus Tunnel
What can trigger vasovagal syncope?
Prolonged standing Standing up quickly Trauma Watching/experiencing medical procedures Micturition Coughing
What are the differences between syncope and seizure with posture?
Syncope - upright posture
Seizure - any posture
What are the differences between syncope and seizure with pallor?
Syn - common
Sei - uncommon
What are the differences between syncope and seizure with onset?
Syn - gradual
Sei - sudden
What are the differences between syncope and seizure with injury?
Syn - rare
Seiz - common
What are the differences between syncope and seizure with incontinence?
Syn- rare
Seiz - common
What are the differences between syncope and seizures with recovery?
Syn - rapid
Sei - slow
What is the difference between syncope and seizures regarding a trigger?
Syn - usually an obvious tigger
Sei - usually trigger is rare
When does a hypoxic seizure occur?
When an individual is kept upright during a Faint
What causes a concussive seizure?
Any blow to the head
Can give a seizure like reaction
Which cardiac arrhythmia can cause syncope?
Long QT syndromes
Bradycardia
Tachycardia
AF in older people
When should cardiac syncope be considered?
When there is a FH of sudden death
When a young person collapses suddenly with exercise
How are affected more with NES?
Women
What can be some features of a NES?
Bizarre movements
Not jerky movements
What investigations should be done for a first possible seizure?
BG
ECG
CT head
What should be considered with a first possible seizure?
Alcohol and drugs
What are the driving regulations for after a first seizure?
After a first seizure, a patient may drive a car after 6 months
- if investigations are normal and no further events
They may drive an HGV or PSV after 5 years
- if investigations are normal, no further events and no anti-epileptic medication
When is epilepsy usually diagnosed?
After 2nd unprovoked attack
What is epilepsy?
Intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
Condition where seizure usually recur spontaneously
What are the classifications of generalised seizures?
Tonic-clonic
Myoclonic
Atonic
Absence seizures
What is a generalised seizure?
When the whole brain is affected
What is a tonic clonic seizure?
Usually affects the whole brain
Has a stiffening and rhythmical jerking pattern
What are the 2 main classes of seizures?
Generalised
Focal
What seizures are classified as generalised?
Tonic clonic Myoclonic Clonic Tonic Atonic Absence
Which seizures are classified as focal?
Focal seizures with retained awareness
Focal seizures with loss of awareness
When is a tonic clonic seizure a medical emergency?
> 5 minutes
Recurring seizures one after the other
What is an atonic seizure?
Type of generalised seizure
There is a sudden loss in muscle tone
Usually causing fall
No convulsion or LOC
What is an absence seizure?
Brief seizures that begin and end abruptly
When you stare into space for a few seconds
Usually occurs exclusively in children
Is there convulsion in atonic seizures?
No
How long does a tonic clonic seizure usually last?
1-3 minutes
What is the most common form of seizure?
Tonic clonic seizure
What happens during a focal seizure with loss of awareness?
Seizure limited to one part of the brain - with no loss of consciousness
What happens during a focal seizure with loss of awareness awareness?
Seizures limited to one part of the brain - with any disturbance of your conscious level
Is there any warning in generalised seizure?
No
With focal seizures is there any warning?
May get an aura
May get a warning
When do generalised seizures usually present?
<25
What can focal seizures either simple partial or complex partialdevelop into?
Secondary generalised
When do focal seizures present?
At any age
Can get a brain abnormality at any age
What is the most useful thing in seizure investigation?
History
Witness history
What investigation should be carried out for primary seizures?
EEG
How can a seizure be evoked?
Sleep deprivation
When should an MRI be given for seizures?
When patient is <50 years
What can be used to exclude serious causes of seizures >50 years?
CT
What is first line daily treatment for generalised epilepsies?
Sodium Valproate
Lamotrigine
What is first line daily treatment for partial and secondary generalised seizures?
Lamotrigine
Carbamazepine
What is the first line daily treatment for absence seizures?
Ethosuximide
What is second line treatment for generalised epilepsy?
Levetiracetam
Topiramate
What are the side effects of sodium valproate?
Teratogenic
Nausea
Pancreatitis
Transient hair loss
What are the side effects of Carbamazepine?
ataxia, drowsiness, nystagmus, blurred vision
What are the side effects of lamotrigine?
Skin rash
difficulty sleeping
What are the side effects of levetiracetam?
Irritability
Depression
What is the driving advice for epilepsy?
Patients can hold a Group 1 licence once they have been seizure free for a year or have only had seizures arising from sleep for a year.
Day time seizure with a nocturnal pattern must have been developed for 3 years
hold a HGV or PSV licence if they have been seizure free for 10 years
not on anti-epileptic medication
What is status epilepticus?
Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
What is the effect on the brain of status epilepticus?
Very metabolically demanding on the body
Eventually brain cells will be damaged
What is the first line treatment for status epilepticus?
Lorazepam
Midazolam
Diazepam
When should midazolam be repeated?
after 10 mins
When should lorazepam be repeated?
After 10 mins
Once
What is the 3rd line treatment for status epilepticus?
Anaesthesia
What is the 2nd line treatment for status epilepticus?
IV Phenytoin
IV Valproate
What is SUDEP?
Sudden unexpected death in epilepsy
If midazolam, lorazepam and diazepam have been given to a patient in status epilepticus with no effect what should you do next?
Repeat the medications used
What are types of focal seizures?
Simpe partial seizure/retained consciousness
Complex partial seizure/unretained consciousness
Who should you avoid giving levetiracetam to?
Avoid in those with underlying mental health issues
1st line Rx for focal seizures:
Carbamezepine or lamotrigine
2nd line Rx for focal seizures:
Sodium valproate or topiramate
3rd line Rx for status epilepticus
ICU support
Anaethesia
